'The Liberal Democrats are right to pursue measures to make the NHS more responsive to local people. Involving patients in decisions about their care and encouraging greater individual responsibility are central to the development of a more modern and productive NHS.

'It is vital to look for ways to empower patients to engage in decisions about their care. Publication of Patient-Reported Outcome Measures would be a welcome move to help patients make informed choices and to drive up standards. But setting patient entitlements can be a thorny issue. Constant development of new products and services would mean any guarantees would have to be very fluid and would likely provoke irresolvable arguments over what should be in and out of any benefits package.

‘While direct payments have been successful in social care, their effective use in health care is more of a challenge. Getting the initial payment level right is the first hurdle, and schemes could end up being costly as recipients would be likely to spend up to the limit irrespective of whether their condition really required it. There is also the danger that converting NHS services into cash could allow the better off to enhance their allowance thereby creating a two-tier service, which undermines the founding principles of the NHS.

'The Liberal Democrats are right to want to devolve more power to local NHS bodies. Electing PCT boards is one of many ideas on how to improve accountability and deserves further discussion. But it would not address the fundamental problem of weak local commissioning. Making services more responsive to local people requires robust local commissioning with a clear vision and co-operation between GPs and PCTs.

'Local tax-raising powers would do little to devolve any real power to local bodies when such a huge proportion of NHS funding would be provided centrally.'

Notes to editors

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The King’s Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through funding. We are a major resource to people working in health and social care, offering leadership development programmes; seminars and workshops; publications; information and library services; and conference and meeting facilities.